Andhra Pradesh

Visakhapatnam-II

cc/430/2011

Padala Chinnari - Complainant(s)

Versus

Reliance Life Insurance Company Limited - Opp.Party(s)

Adari Appa Rao

05 Jun 2015

ORDER

                                              Date of Registration of the Complaint:09-11-2011 

                                                                                                Date of Order:05-06-2015

BEFORE THE DISTRICT CONSUMERS FORUM-II AT

                                VISAKHAPATNAM

 

P  r  e  s  e  n  t:

1.  Sri H. Ananda Rao, M.A., L.L.B.,

     President           

2. Smt K. Saroja, M.A. B.L.,

     Lady Member 

                                3. Sri C.V. Rao, M.A., B.L.,

                                     Male Member

 

                              Friday, the 5^th day of June, 2015.

                             CONSUMER CASE No.430/2011

Between:-

Smt. Padala Chinnari, W/o Chinnarao, Hindu,

aged 28 years, Ramapuram Village, near A.M.A.L.

College, Kothuru, Anakapalle Mandal,

Visakhapatnam District.

                                                                                                     ….. Complainant

And:-

1.The Regional Manager, Reliance Life

    Insurance Company Limited, Sri Balaji

    Mangalagiri Complex, Siripuram,

    Visakhapatnam-530 003.

2.The Branch Manager, Reliance Life Insurance

   Company Limited, besides Ramachandra Theatre,

   Chodavaram Road, Anakapalle, Visakhapatnam

   District.

                                                                                           …  Opposite Parties

                     

This case coming on 22.05.2015 for final hearing before us in the presence of Sri Adari Appa Rao Advocate for the Complainant and Sri  A. Babu Rao, Advocate for the Opposite Parties and having stood over till this date for consideration, this Forum made the following:

 

                                                ORDER

        (As per Smt. K. Saroja Honourable Lady Member on behalf of the Bench)

 

1.       The case of the Complainant in brief is that the Complainant’s husband viz., Padala Chinna Rao had obtained a Life Insurance Policy from the Opposite Parties bearing No.16530140 for an amount of Rs.9,00,000/-.  The said policy is commenced from 12.03.2010.   The Complainant was showned as nominee in the said policy.   On 10.06.2010 the insured was suffering from fever and he was shifted to Government Hospital, Anakapalle and treated as outpatient.   Then he was shifted to Shri Shirdi Sai Hospital for better treatment and died on 13.06.2010.    The Complainant went to the 2^nd Opposite Party office on 04.12.2010 and submitted Original Policy Bond, Original Death Certificate, Original Prescriptions, filled Claim forms, photo copy of Bank Pass Book and photo copy of Ration Card and other relevant documents for settlement of claim.   Inspite of many requests made by the Complainant and approached several times, the Opposite Party did not settle the claim.   The Complainant approached the 2^nd Opposite Party in the month of March, 2011 and August, 2011 but the Opposite Parties kept silent.   Hence, this Complaint.

2.       a) For an amount of Rs.9,00,000/- (Rupees Nine lakhs only) together with interest at the rate of 24% per annum on it from the date of claiming the amount till its payment;

          b) Compensation of Rs.50,000/-  towards and mental agony, pain and suffering;

          c) For the costs of the Complaint and

          d) For such other relief or relief’s as this Forum deems fit and proper under the circumstances of the case.

 

3.       The 1^st Opposite Party strongly resisted the claim of the Complainant by contending, as can be seen from their counter.   On report of the claim and statement the Opposite Parties appointed an investigator to investigate into the claim of the Complainant.   As per their investigator report dated 28.02.2011 it was revealed that Mr. Padala Chinna Rao actually died on 14.08.2009 i.e., prior to the alleged date of application for insurance i.e., 09.03.2010.   The Complainant had falsely and fraudulently reported date of death Mr. Padala Chinna Rao in the Register of Registrar of Births & Deaths was on 13.06.2010.   As per Aangan Wadi report actual date of death of the Mr. Padala Chinna Rao was noted as on14.08.2009.   So, they have no liability to pay any reliefs asked by the Complainant as Mr. P. Chinna Rao died in the year, 2009 whereas the policy obtained in the year, 2010.

 

4.       At the time of enquiry, both parties filed affidavits as well as written arguments to support their contentions.   Exs.A1 to A7 and Ex.B1 to B11 are marked for either side.

 

 

5.       Ex.A1 is the photo copy of Policy Schedule issued by the Opposite Parties in favour of the Complainant dated 12.03.2010.    Ex.A2 is the photo copy of Out-patient Slip issued by the Area Hospital, Anakapalle dated 10.06.2010.    Ex.A3 is the photo copy of Treatment Details issued by Sri Shirdi Sai Hospital in favour of the deceased P. Chinna Rao dated 10.06.2010.   Ex.A4 is the original Death Certificate issued by the Panchayat Secretary deceased P. Chinna Rao dated 07.07.2010.  Ex.A5 is the photo copy of Death Intimation letter issued by the Complainant to the 2^nd Opposite Party dated 04.12.2010.    Ex.A6 is the photo copy of Death Claim Intimation Acknowledgement issued by the 2^nd Opposite Party to the deceased/insured dated 04.12.2010.    Ex.A7 is the original Repudiation letter issued by the 2^nd Opposite Party to the Complainant dated 31.03.2011.   

 

6.       Ex.B1 is the photo copy of Letter of Authority dated 29.12.2011.   Ex.B2 is the photo copy of the Proposal Form No.2871718 issued by the Opposite Parties in favour of P. Chinna Rao dated 09.03.2010.   Ex.B3 is the photo copy of Claim Form-A issued by the Opposite Parties in favour of the Complainant dated 26.11.2010.   Ex.B4 is the photo copy of Death Claim Investigation issued by Sri Guru Raghavendra Associates dated 28.02.2011.   Ex.B5 is the photo copy of relevant extract from the death register maintained by Aangan Wadi Survey Register-Personal Family Record dated 14.08.2009.    Ex.B6 is the photo copy of Death Certificate of deceased issued by the Panchayat Secretary dated 02.07.2010.   Ex.B7 is the photo copy of repudiation letter issued by the 2^nd Opposite Party to the Complainant dated 31.03.2011.   Ex.B8 is the original Death Certificate issued by the GVMC in favour of the deceased/insured dated 18.08.2014.    Ex.B9 is the office copy of letter of Authority issued by the Opposite Parties dated 10.10.2014.    Ex.B10 is the original affidavit for appointment of Sri Guru Raghavendra Associates dated 14.07.2012.   Ex.B11 is the photo copy of letter of Cancellation False Claim addressed by the Complainant to the Branch Manager, Reliance Life Insurance Company Limited, Mumbai dated 16.12.2010.

7.       Ex.C1 is marked for the Padmaja Hospital, Gajuwaka, Visakhapatnam on 23.02.2015.    

 

8.       The fact shown from Ex.C1 reveals that the insured/deceased died on 03.08.2009.   Ex.C1 reveals that Mr. P. Chinna Rao, who was said to have expired on 03.08.2009.   Our admission register shows that this patient was admitted in our hospital on 02.08.2009 and discharged on 3.8.2009 we have not issued any death certificate which indicates that the death had not happened in our hospital.

 

9.       The point that would arise for determination in the case is:-

Whether there is any deficiency in service on the part of the Opposite Parties.   Whether the Complainant is entitled to any reliefs asked for?

 

10.       After careful perusal of the case record, this Forum finds that the  insured/deceased obtained insurance policy from the Opposite Parties for an amount of Rs.9,00,000/- is not indispute but the Opposite Parties disputing the death of the date and the year of the insured.   As per the Complainant’s documents date of death of the insured was on 13.06.2010, whereas the Opposite Parties filed Death Certificate of P. Chinna Rao was died on 03.08.2009 i.e., before taking the insurance policy.   As per the affidavit and counter of the Opposite Parties, the insured died on 14.08.2009 whereas the documents filed by the Opposite Parties i.e., the death certificate of insured shown as on 03.08.2009 are unsubstantiated.   We are of the opinion, that these documents are fabricated.    As such, the Complainant suffered a lot of mental agony, financial and physical strain by the acts of the Opposite Parties as the Opposite Parties repudiated the claim of the Complainant with false allegations amounts to deficiency in service on the part of the Opposite Parties.   As per their investigator report the insured died on 14.08.2009 but the documents filed by the Opposite Parties are different.   We are of the opinion that the insured Padala Chinna Rao and the document produced by the Opposite Party i.e., Ex.B8 is the death certificate of P. Chinna Rao is different.   Ex.C1 reveals that the hospital authorities stated that they did not issue any death certificate as he did not expire in their hospital.   But the document produced by the Opposite Party i.e., Ex.B8 reveals that the place of death was occurred in Padmaja Hospital.   Hence, the Complainant is entitled to insurance amount with interest, some compensation and costs too.

 

 

11.     In the result, this Complaint is allowed directing the Opposite Parties:  a) to pay insurance amount of Rs.9,00,000/- (Rupees Nine lakhs only) with interest @ 9% p.a. from 04.12.2010 till the date of actual realization, b) a compensation of Rs.50,000/- (Rupees Fifty thousand only)  and c) Costs of Rs.2,500/- (Rupees Two thousand and five hundred only) to the Complainant.   Time for compliance, one month from the date of this ordser.

 

Dictated to the Steno, transcribed by him, corrected and pronounced by us in the Open Forum, this 5^th day of June, 2015.         

             

Sd/-                                      Sd/-                                       Sd/-                                  

President                              Male Member                      Lady Member

                                     

 

APPENDIX OF EVIDENCE

For the Complainant:-

NO.	DATE	DESCRIPTIONOFTHEDOCUMENTS	REMARKS
Ex.A01	12.02.2010	Policy Schedule issued by the Opposite Parties in favour of the Complainant	Photo copy
Ex.A02	10.06.2010	Out-patient Slip issued by the Area Hospital, Anakapalle	Photo copy
Ex.A03	10.06.2010	Treatment Details issued by Sri Shirdi Sai Hospital in favour of the deceased P. Chinna Rao	Photo copy
Ex.A04	07.07.2010	Death Certificate issued by the Panchayat Secretary deceased P. Chinna Rao	Original
Ex.A05	04.12.2010	Death Intimation letter issued by the Complainant to the 2nd OP	Photo copy
Ex.A06	04.12.2010	Death Claim Intimation Acknowledgement issued by the 2nd OP to the Complainant	Photo copy
Ex.A07	31.03.2011	Repudiation letter issued by the 2nd OP to the Complainant	Original

For the Opposite Parties:-                                          

NO.	DATE	DESCRIPTIONOFTHEDOCUMENTS	REMARKS
Ex.B01	29.12.2011	Letter of authority	Photo copy
Ex.B02	09.03.2010	Proposal Form No.2871718 issued by the Ops in favour of P. china Rao	Photo copy
Ex.B03	26.11.2010	Claim  Form-A issued by the Ops in favour of the Complainant	Photo copy
Ex.B04	28.02.2011	Death Claim Investigation issued by Sri Guru Raghavendra Associates	Photo copy
Ex.B05	14.08.2009	Relevant extract from the death register maintained by Aangan Wadi Survey Register-Personal Family Record	Photo copy
Ex.B06	02.07.2010	Death Certificates of deceased issued by the Panchayat Secretary	Photo copy
Ex.B07	31.03.2011	Repudiation letter issued by the 2nd OP to the Complainant	Photo copy
Ex.B08	18.08.2014	Death Certificate issued by the GVMC in favour of the deceased/insured	Original
Ex.B09	10.10.2014	Letter of Authority issued by the Ops	Office copy
Ex.B10	14.07.2012	Affidavit for appoint of Sri Guru Raghavendra Associates	Original
Ex.B11	16.12.2010	Letter of Cancellation False claim addressed by the complainant to the Branch Manager, Reliance Life Insurance Company Limited, Mumbai	Photo copy

 

NO.	DATE	DESCRIPTIONOFTHEDOCUMENTS	REMARKS
Ex.C1	23.02.2015	Letter sent by the Padmaja Hospital, Gajuwaka, VSP	Original

 

Sd/-                                  Sd/-                                               Sd/-

President                          Male Member                                Lady Member